HomeMy WebLinkAbout48360-Z �0�0511fFQt�-�O Town of Southold 11/29/2022
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O P.O.Box 1179
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�' _ 53095 Main Rd
,�j01 r Southold New York 11971
CERTIFICATE OF OCCUPANCY
No: 43630 Date: 11/29/2022
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 365 Rachaels Rd,Mattituck
SCTM#: 473889 Sec/Block/Lot: 108.4-7.45
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/3/2022 pursuant to which Building Permit No. 48360 dated 10/3/2022
was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
electric for accessory storage building_
The certificate is issued to Loper, Shawn&Van Ellen,Debora
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48360 10/19/2022
PLUMBERS CERTIFICATION DATED
Authorized Signature
.oSUF¢Qlkc. TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x TOWN CLERK'S OFFICE
t � SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 48360 Date: 10/3/2022
Permission is hereby granted to:
Loper, Shawn
365 Rachaels Rd
Mattituck, NY 11952
To: Electric in shed
At premises located at:
365 Rachaels Rd, Mattituck
SCTM # 473889
Sec/Block/Lot# 108.-4-7.45
Pursuant to application dated 10/3/2022 and approved by the Building Inspector.
To expire on 4/3/2024.
Fees:
ELECTRIC $125.00
Total: $125.00
BuildinInspector
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Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 Q sean.deviina-town.southold.ny.us
Southold,NY 11971-0959 Q
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Shawn Loper
Address: 365 Rachels Rd city:Mattituck st: NY zip: 11952
Building Permit#: 48360 Section: 108 Block: 4 Lot: 7.45
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: AS BUILT License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Surrey X Attic Garage X
INVENTORY
Service 1 ph Heat Duplec Recpt 6 Ceiling Fixtures 4 Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures 2 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel 100A A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 3 4'LED Exit Fixtures Pump
Other Equipment:
Notes: " AS BUILT NO VISUAL DEFECTS " Shed / Garage
Inspector Signature: Date: October 19, 2022
S.Devlin-Cert Electrical Compliance Form
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# # TOWN OF SOUTHOLD BUILDING DEPT.
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INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION ] PRE C/O , [ ] RENTAL
REMARKS: !T''� ,r
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DATE I at INSPECTOR
OCT 0 3 2022
Sk�ffnLA" BUILDING DEPARTMENT- Electrical Inspector
TOr: - TOWN OF SOUTHOLD
_.
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
off' Telephone (631) 765-1802 - FAX (631) 765-9502 ,
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1 'X'` •;. rogerr(cr7southoldtownny.gov sea nd(cb-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION r
ELECTRICIAN INFORMATION (AII Information Required) Date:
.Company Name: 9,04e &0,*1lei2.
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: C]I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: IN �.oPfi�l7JJ2
Address': b AGGi 5 l� ll�S�2
Cross Street:
Phone No.: -to 3 tn 0 3"3 fed
Bldg.Permit #: VeW email: JV i ya�.r��ayr ,4 ft
Tax Map District: 1000 Section: Block: Lot: :5 s
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE,F OT EPease,Print Clearl ,
$�l b-a4 deN Pu-A. NP //1 2003 �f/ �yJ,e/ t✓i� rwii7/ a SZ
S� e Land n,e ped e,/4Z_
Square Footage: �gy
Circle All That Apply:
Is job ready for inspection?: YES NO Rough In [ Final
1
Do you need a Temp Certificate?: —1 YES [ NO Issued On
Temp Information: (All information required)
Service Size[1 Ph[3 Ph Size: A '# Meters— Old Meter#
[]New Service[]Fire Reconnect[]Flood Reconnect[]Service Reconnect[]Underground[]Overhead
# Underground_Laterals 1 2 R H Frame D Pole Work done on Service? nY N
Additional Information:
PAYMENT DUE WITH APPLICATION PLC 1C ��